June 25, 2019

Risky Business

Risky Business

The Cancellation

A couple had their insurance coverage terminated by their insurer owing to non-payment of premium. The woman was unfortunately in the middle of pregnancy with their first child. They received a letter stating that the coverage they had been using for nearly two years had been cancelled. It cited non-payment...


Military insurance fraud

A former pharmacist has been sentenced to two years in prison for his involvement in a health-care kickback scheme that defrauded a military insurance program. He colluded with owners of the pharmacy involved in the insurance program. He conducted a sham medical study that claimed to evaluate the safety and...


Shutting shop

A trucking company has been forced to close its doors and lay off all its staff owing to rising insurance costs. The owner said that the burgeoning insurance costs and charges for the settling claims were forcing him to make the decision. Sad circumstances indeed.


Erroneous funding

Around 50,000 customers of an insurance company were accidently charged twice for their health insurance policies. Customers had double the fees taken out of their accounts due to a glitch in the system. Many of these customers took to social media to cry foul and to understand refunding processes. The...


Protected by the law

A couple set up a law firm (yes, a law firm!) as a front to defraud an insurance company. One among them – the woman –  was hired to manage the underwriters insurance claims. The couple then wrote up false invoices for legal services supposedly provided which were then sent...


The ringleader

A man has been sentenced to five counts of presenting fraudulent claims for insurance payment. He was allegedly the ring leader of a gang of 21 suspicious persons committing similar transgressions. The insured coordinated and staged five different incidents in one location and two others in adjoining locales. Accidents that...


Duplicate claims

Three advocates who filed duplicate insurance claims for the same motor accident case were recently suspended from practice for a five-year term by a disciplinary committee of their respective Bar Council. Their transgressions had initially come to light last year when the insurance company approached judiciary. The case eventually prompted the judiciary to...


Life ‘floats’ by

A woman’s home was caught in the middle of flash flooding, forcing her to go by boat to retrieve her belongings. She said the bottom floor of her home was filled to the brim with water inching closer to the living room. Her family and friends helped her pack up...


Pay day

Some insurers are now picking up on a trend of skipping the provider and sending massive checks for treatment directly to the patient. A lawsuit was promptly issued by the provider, a signal of an ongoing war between the payer and provider. And misuse by the patient is therefore a...


Jewellery fraud

A woman was charged with theft after she was found to have failed to report that she recovered her missing jewellery after receiving her insurance claim settlement. The insured had a filed a claim five months before she found her bracelet in her purse. The policy expressly stated that if...

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